BACKGROUND There are many mHealth apps for older adult patients, but research has found that, broadly speaking, mHealth still fails to meet the specific needs of an older adult user. Others have highlighted the need for embedding the user in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps, and is described as involving stakeholders in each phase of the design/development process. Involvement of older adults in co-design processes has been variable. Co-design approaches to date have tended towards embedding the stakeholders in early phases (e.g., pre-design/generative) but not throughout. OBJECTIVE The aim of this paper is to provide reflections on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. The aim was to design an mHealth tool to assist older adults to coordinate their care with healthcare providers and caregivers. METHODS Our work to conceptualize, develop and test the mHealth app consisted of four phases: Phase 1- consulting stakeholders; Phase 2- app development and co-designing with older adults; Phase 3- field testing with a smaller sample of older adult volunteer testers; and Phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 12, using team-based thematic analysis. RESULTS In Phase 1, we identified key features that older adults and health care providers wanted in an app, and each user group identified different priority features (older adults principally sought supports to use the mHealth app, while providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what older adult users wanted, and what our developers were able and willing to deliver. In Phase 4 we reflected on our abilities to embed the voices and perspectives of older adults throughout the project, when working with a developer not familiar or committed to the core principles of co-design. CONCLUSIONS While our final mHealth app did not reflect all of the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. Furthermore, our reflective process identified important factors to consider when health researchers and gerontologists set into the app development sector.
BACKGROUND Integrating culturally competent approaches in the provision of healthcare services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of healthcare providers in order to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among healthcare workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults. OBJECTIVE We seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of culturally competent interventions for health professionals who work with racialized foreign-born older adults. The aim of this paper is to describe the protocol for this review. METHODS Our protocol will follow the PRISMA guidelines (PRISMA-P) for systematic review protocols. We will conduct a systematic search for relevant studies from three electronic databases that focus on health and social sciences (PubMed, CINAHL, and Scopus). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research. RESULTS The systematic review is currently at the search phase where authors are refining the search strings for the selected databases. We expect that the systematic review will be completed within 18 months from the publication of the protocol paper. CONCLUSIONS This study will inform future development and implementation of interventions to support culturally competent, person-centered care of racialized immigrant older adults.
Background Integrating culturally competent approaches in the provision of health care services is recognized as a promising strategy for improving health outcomes for racially and ethnically diverse populations. Person-centered care, which ensures patient values guide care delivery, necessitates cultural competence of health care providers to reduce racial/ethnic health disparities. Previous work has focused on interventions to improve cultural competence among health care workers generally; however, little investigation has been undertaken regarding current practices focused on racialized foreign-born older adults. Objective We seek to synthesize evidence from existing literature in the field to gain a comprehensive understanding of interventions to improve the cultural competence of health professionals who care for racialized foreign-born older adults. The aim of this paper is to outline a protocol for a systematic review of available published evidence. Methods Our protocol will follow the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Protocols) for systematic review protocols. We will conduct a systematic search for relevant studies from four electronic databases that focus on health and social sciences (PubMed, CINAHL, Scopus, and Cochrane Database). After selecting relevant papers using the inclusion and exclusion criteria, data will be extracted, analyzed, and synthesized to yield recommendations for practice and for future research. Results The systematic review is currently at the search phase where authors are refining the search strings for the selected databases; the search strings will be finalized by July 2022. We anticipate the systematic review to be completed by December 2022. Conclusions This study will inform the future development and implementation of interventions to support culturally competent, person-centered care of racialized foreign-born older adults. Trial Registration PROSPERO CRD42021259979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259979 International Registered Report Identifier (IRRID) PRR1-10.2196/31691
Introduction: Health care organizations are increasingly recognizing the need to integrate the health care system to better care for older adults. We partnered with a local health centre to inform the development of a Regional Frail Senior Strategy for Southwestern Ontario, Canada.Methodology: Interviews were conducted with 12 older adults (65+, with chronic conditions) and family caregivers. 44 interviews were also completed with health care providers from across the region. To engage with a range of stakeholders on the strategy, four feedback fairs were hosted. Interviewees emphasized the importance of person and family-centred care, integration of health care services, issues of access, and further training and education for health care professionals. Findings and stakeholder feedback were synthesized into 14 recommendations. Discussion:The data and recommendations outlined in this paper informed the development of the frailty strategy for a region in Ontario. Participatory methods and stakeholder engagement identified pertinent themes related to enhancing care for older adults with frailty. Conclusion:The creation of a frailty strategy is imperative in recognizing and responding to the needs of older adults with complex conditions. Our approach may be relevant to other organizations and health systems interested in developing their own regional frailty strategies.
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